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Following inquiries from GP Speak and sustained pressure from various quarters, including the Royal Australasian College of Physicians and the Ted Noffs Foundation, as well as a threat by the NSW Greens to have parliament force the document’s release, the Berejiklian government has made public the special Commissioner’s report into the drug ‘Ice’ (crystal methamphetamine) and other illicit substances.

The four-volume report follows the Commission’s exhaustive hearings in Sydney and various regional settings, including Lismore, where drug experts, including ex-users, spoke of an epidemic of ‘ice’, the widespread misuse of other illicit drugs (and, notably, alcohol), and highlighted the lack of treatment and other support services in both the legal and health systems.

Civilisation has come a long way in 5,000 years. The English philosopher Thomas Hobbes described the natural state of man as “solitary, poor, nasty, brutish and short”. He argued that this could be addressed by ceding one’s liberty to the Crown in exchange for an enjoyment of the benefits that society brings. An individual’s basic needs for food, shelter and clothing would thus be met.

Times have changed. More recently economists have argued that sanitation, education, healthcare and the internet be added to the list. That’s progress, but on the North Coast many of us will have patients living below the new poverty line.

With an expanded list of wants and needs the government is faced with the dilemma of finding the ways and means to fulfill them. Since wants are endless this is an impossible task.

The best the government can do is prioritise the needs and find the most efficient way to deliver the services. In totalitarian states the party determines the activities, in democracies every few years the electorate can choose from two or more alternative paths.

While many regard this as an improvement it does not address the problem of the tyranny of the majority. In pluralistic societies like America and Australia the majority of the electorate will vote, perhaps manipulated by media old and new, in their own self interest. While this is rational for the individual it raises problems such as degradation of the environment for future generations and tax laws that see the transfer of wealth from the young to the old.

So how best can the government address the wants and needs of the Australian public?

Notable delays for public patients requiring endoscopy, especially colonoscopy, procedures are set to become even longer following a decision by consultant gastroenterologist Howard Hope to discontinue accepting referrals for patients needing upper GI endoscopy or colonoscopy at Lismore Base Hospital (LBH).

In a letter of 9 February 2020 to local referring doctors and other relevant parties, a clearly exasperated Dr Hope said the “prime reason is the excessive waiting times for public endoscopy at LBH, especially for colonoscopy.”

He stated that he and colleagues had been discussing the long waiting times with LBH management for many years.

In December 2019 he asked LBH managers to create a public Outpatient Clinic for gastroscopy and colonoscopy referrals. Referral to this open access Outpatient Clinic would help reduce the delay from GP referral to the appropriate procedure.

He added “The fundamental problem is that endoscopy waiting times (compared with surgical waiting times) are not a reportable performance indicator for hospital managers. In my opinion this is a serious failure of the NSW Department of Health policy.”

The Covid-19 pandemic has brought about the greatest dislocation to Australian society since World War 2. Changes to work and life are affecting all members of the community and have required wholesale changes to the way we do things.

Restricting exposure to each other has been the key to flattening the curve and Australia’s success has been amongst the best in the world. Unfortunately this has left many Australians out of work and some industries have been completely shut down. Nevertheless, many aspects of society need to keep functioning, not the least medical care.

As part of the national response to the Covid-19 pandemic, the Federal government has made extensive changes to the availability of telehealth. While physical examination is a basic element in clinical diagnosis much of our routine care can be accomplished without it.

Some GPs have recently had difficulties in coordinating care for suspected Covid-19 patients. Dr Brian Hughes of the LBH Fever Clinic provides a quick update for the current situation on the North Coast.

Criteria for being seen at the Covid-19 Clinic have changed rapidly over the last two weeks. The criteria as of 8 April 2020 are: